Savants are people who despite serious mental or physical
disability have quite remarkable, and sometimes spectacular, talents. This is an
exceedingly rare phenomena, although there are several well documented cases
(see Sacks, 1986; 1995; Treffert, 1989), and recently the Academy Award winning
movie Rain Man has led to the term savant being much more
widely known. Savant syndrome is perhaps one of the most
fascinating phenomena in the study of human differences and cognitive
psychology. It is often claimed that, because of the extraordinary abilities
involved, we will never truly understand human memory and cognition until we
understand the savant.

Savant syndrome was first properly recognised by Dr. J.
Langdon Down, (n.b. he also originated the term Down’s syndrome). In
1887, he coined the term "idiot savant" - meaning low intelligence,
and from the French, savoir, knowing or wise, to describe someone
who had "extraordinary memory but with a great defect in reasoning
power." This term is now little used because of its inappropriate
connotations, and the term savant syndrome has now been more or less
adopted. Another term, autistic savant, is also widely used, but
this can be somewhat misleading. Although there is a strong association with
autism, it is certainly not the case that all savants are autistic. It is
estimated that about 50% of the cases of savant syndrome are from the autistic
population, and the other 50% from the population of developmental disabilities
and CNS injuries. The estimated incidence of savant abilities in the autistic
population is about 10%, whereas the incidence in the learning disability
population (which is very much larger) is probably less than 1%. Nevertheless,
in order to understand savant syndrome, it is helpful to know something about autism,
also it is important to realize that there is some confusion over these
estimates of the incidence of the syndrome which stems from the different ways
in which it is defined and described.

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What
is Autism?

Autism is a moderately rare condition resulting from a complex
developmental disability that typically appears during the first three years of
life. It is a neurological disorder that affects the functioning of the
developing brain, resulting in sometimes profound communicative, social and
cognitive deficits. Autism is estimated to occur in as many as 1 in 500
individuals, and is four times more prevalent in boys than girls and does not
seem to be associated with any demographic features, such as economic, class,
racial, ethnic, etc. Autistic traits are also sometimes observed
in connection with other developmental disabilities, and CNS injuries.

The term autistic was first used by Eugen Bleuler in
1908, but the condition of autism was first named and described by the
psychiatrist, Leo Kanner, in a landmark paper published in 1943. It is a
condition in which children and adults typically have a lowered level of
intelligence, together with difficulties in verbal and non-verbal communication,
in the skills of social interaction, and in play activities. The disorder makes
it hard for them to relate to the outside world, and there is a marked tendency
to withdraw from human interactions and become preoccupied with attachment to
objects. There is a failure in human intersubjectivity, characterized by
difficulties in joint action, turn taking, and shared activities. Aggressive
and/or self-injurious behaviour may well be present. Often there will be
continuous repetition of body movements (hand flapping, rocking), a rigidity of
actions, resistance to changes in routine, and a "desire" for
sameness. Independently of Kanner, in 1944 Hans Asperger, an Austrian physician,
described a very similar condition, although there were some subtle differences.
In 1981, Lorna Wing adopted the term Asperger’s syndrome in
referring to a group of people who did not fit the strict criteria for autism,
and were relatively high functioning (see Happé, 1994 for a fuller account).

It is probably best to think of autism as a spectrum
disorder. For example, DSM-IV includes autism, grouped together with
several related disorders, under the broad heading "Pervasive
Developmental Disorder (PDD)." This is a general category of disorders
which is characterized by severe and pervasive impairment in several areas of
development. There are no medical criteria for diagnosing autism, a specific
diagnosis is made when a specified number of characteristics are noted as
present, based on the presence of specific behaviours indicated by observation
and through parent consultation. Individuals who fall under the PDD category in DSM-IV
exhibit commonalties in communication and social deficits, but may differ in
terms of severity. Defining autism as a spectrum disorder, recognizes
that the symptoms and characteristics of autism can present themselves in a wide
variety of combinations, which may also range from mild to severe. Clearly,
there is no standard "type" or "typical" person with autism,
and the terminology in use includes: autistic traits, autistic tendencies,
autism spectrum disorder, high-functioning or low-functioning autism. However,
this lecture is not concerned directly with autism, its definition or diagnosis.

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Characteristics
of Savant Syndrome

Savant syndrome is exceedingly rare, but a remarkable
condition in which persons with autism, or other serious mental handicaps, or
major mental illness, have astonishing islands of ability or brilliance that
stand out in stark contrast to their overall disability. The condition can be
congenital or be acquired by an otherwise normal individual following CNS injury
or disease. It occurs in males more frequently than in females in an approximate
ratio of 6 to 1. The skills can appear suddenly, without explanation, and have
been reported as sometimes disappearing just as suddenly. It is useful to put
these special skills into the following three categories: Splinter Skills
where the individual possesses specific skills that stand in contrast to their
overall level of functioning, Talented Savants where the
individual displays a high level of ability that is in contrast to their
disability, and Prodigious Savants which involves a much rarer
form of the condition, where the ability or brilliance is not only spectacular
in contrast to the disability, but would be spectacular even if viewed in a
non-disabled person. It is very likely that many savants do go unnoticed, and
depending upon whether the three categories above are recognized, estimates of
the incidence of savant syndrome can vary widely. In the case of prodigious
savants it has been estimated that there may be fewer than 100 cases reported in
the world literature in the past 100 years.

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Categories
of Savant Skill

Savant skills occur within a narrow but fairly constant range
of human mental functions. If they have anything in common it is that they all
more or less involve considerable feats of memory. In some cases a specific
skill might exist, while in others there may be several skills that co-exist
simultaneously. An important observation is that the skills tend to be right
hemisphere oriented: i.e. non-symbolic, artistic, concrete, directly perceived.
Table 1 describes some of the striking abilities that have been found in
savants.

Table 1:
Savant Skills(n.b. the focus here is on examples of
prodigious savants)

Memorization - superior memory
is a common feature of savant syndrome, but it also can be a special skill
in its own right. There are cases of savants who have memorized population
statistics, telephone books, bus scheduals, and in one remarkable case the
9 volume edition of Grove’s Dictionary of Music and Musicians (The
Walking Grove, Sacks, 1986).

Lightening calculation - this
is exhibited in the instantaneous calculation of multiplications, square
roots, etc, the determination of prime numbers, or subitizing (The
Twins, Sacks, 1986).

Calender calculating - often
involving the ability to identify the day of the week upon which a
particular date falls, in one case any time in the last, or next, forty
thousand years!! (The Twins, Sacks, 1986).

Musical ability - this is a
relatively common savant skill, the co-occurrence of musical genius,
blindness and learning disability is a striking feature here. Savants will
have perfect pitch, and can play a complete piece of music after hearing
it only once (see Hermelin, 2001).

Artistic ability - not as
common as musical abilities, but there are savants with exceptional
painting, sculpture and especially drawing skills. e.g. Nadia (Selfe,
1977) and Stephen Wiltshire (1987; 1991; see also Sacks, 1995; Hermelin,
2001). See also The Autistic Artist in Sacks (1986).

Language ability - this is
fairly rare, but there is one well documented case of a savant with CNS
damage since birth who could read write and translate 15 to 20 languages
(Smith & Tsimpli, 1995; Hermelin, 2001). Hermelin also includes a case
of a savant poet.

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Theories
of Savant Syndrome

The reason why some autistic and disabled individuals have
savant abilities is not understood, however, the strong link with autism does
offer a good starting point. There have been many theories, but it is
clear that no one theory is sufficient. Theories include: Biological-Developmental
- such as genetic, neurochemical, left hemisphere dysfunction, frontal and temporal lobe damage,
and the DSM IV diagnostic category is Pervasive Developmental Disorder (PDD); Cognitive - such as deficits in executive
function and abstract thinking; weak coherence theory; highly developed procedural
memory and eidetic imagery (Happé, 1994; Schopler & Mesibov, 1995). Other theories include a deficit in theory of
mind (Frith, 1989), compensation for sensory disabilities (especially
blindness) and social isolation,
and the modularity of mind hypothesis which proposes that particularly
when executive cognitive functions are disrupted the mind exhibits a striking
modular organization (see Smith & Tsimpli, 1995). However, any theory would need to explain the link with
autism, the islands of exceptional ability, the bias towards male
savants, and recent research that includes a finding of the emergence of savant
abilities in fronto-temporal dementia patients, and the suggestion of a
neurotoxic effect of circulating testosterone on the left hemisphere in the male
fetus possibly related to autism.

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Some
Management Issues

There are two necessary components of the savant syndrome: (i)
a remarkable ability to memorize, to record detail, or repeat an operation
endlessly and efficiently, and (ii) a means of giving expression to this
ability. The importance of (ii) should not be underestimated. Not only are
savants noticed by this expression of their special abilities, but also savants
like doing something, and doing it again, again and again. No one has any idea
how many savants go unnoticed. In the case of prodigious savants it is possible
that early recognition and careful encouragement are important contributory
factors to how the talent develops.It has been proposed that helping the
savant to achieve a higher level of general functioning may result in a loss of
the special savant skills. However, there is little evidence for this, and it
may well be that "training the talent" could be a valuable approach
towards improving socialization, communication and self-esteem.

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A
illustrative case example: Tim, age 40+

Tim has profound sensory and communicative disabilities (his
identity has been concealed). He lives in a residential home with day care
facilities for adults with learning difficulties, and has been in residential or
institutional care since the age of 15. He has no hearing and
consequently no speech. He has moderate physical difficulties and sometimes he
requires a wheelchair. Tim has probably been disabled since very early
childhood, and it is believed that he has been diagnosed as having
"autistic traits." But, as far as it is known, his medical records
have been destroyed. He has a previous history of challenging behaviour and mood
swings, which has in the past been controlled with powerful anti-psychotic
drugs. These have been greatly reduced over the 5 years that he has been living
at his current residential home, during which time there have been striking
changes in his behaviour, including a particularly marked reduction in his
challenging behviour. The most likely reason for this is due mainly
to communication barriers being greatly decreased. Despite Tim’s profound
disabilities, he is relatively outgoing and is not withdrawn, and he shows a
remarkable intelligence (although this would be very difficult to measure
formally). He is strong willed, and will only do things that he wants to do. He
is helpful, he values affection, and he is considerate to other residents,
especially in being tolerant of younger residents. Tim has probably received
very little education, he cannot read or write (although he can recognize his
name and a few words, and copy any shape that he wishes), but he has been taught
a system of alternative communication called Makaton. This is a
visual and signing process, usually used alongside speech, which is widely used
in the UK by people with learning disabilities. The Makaton Vocabulary
was designed in 1972 by Margaret Walker, a UK Speech and language Therapist. She
developed Makaton in response to the needs of deaf adults with severe
learning disabilities, particularly who were residents in an institution,
because other sign communication systems were not very satisfactory. Without Makaton,
Tim would only be able to make himself understood with a few crude gestures, and
his life could and would be very confusing and frustrating. Tim uses Makaton
to initiate conversations, to ask questions, and clarify any situation.

Table 2:
Some observations of Tim

Tim draws from memory, and from life

He draws with accurate perspective

He draws with attention to detail

He can draw a good likeness, and can draw a
self-portrait

He can draw a "building plan" with a
ruler

He finds "hair" very difficult

Tim’s drawing involves deliberate use of lines
- "as if tracing an image"

He has a high level of concentration

He is reflective, pausing to think

He chooses his pencils, colours carefully (he
knows which pencil/crayon he needs, which box it is in, and he
will make a very special effort to match "eye colour")

When drawing from life he takes brief infrequent
glimpses

Tim draws what he wants to draw

He likes to draw batteries, light bulbs and lifts

In the past, he did not share his drawings with
others, he folded them up very small and put them in his pocket,
but kept them all in his room

He has developed his own narrative style of
drawing

In addition, he has excellent assembly skills
(e.g. IKEA furniture)

His rigidity has relaxed with improved
communication

When placed within the context of all these disabilities, Tim
possesses extraordinary abilities which primarily are illustrated by his drawing
and his photographic memory. As far as it is known, these extraordinary
abilities have gone unnoticed, or unrecognized, for most of his life. It was my
wife, Elaine, who was the first to recognize Tim’s special abilities. It seems
very clear that Tim falls into the category of a savant. What is
particularly interesting is that very few cases of savants who are profoundly
deaf have ever been documented (the one exception seems to be the case of James
Henry Pullen, see Treffert, 1989). I will demonstrate what I am talking about by
showing you a selection of his drawings. I will point out a number of features
that show how his abilities fit well with those usually attributed to savant
syndrome (see Table 2). His drawings are deceptively simple, and it is easy to
underestimate the level of his achievements. I will draw especially upon the
work of David Hockney (2001) who has recently uncovered some of the techniques
used by the old masters in their paintings. Tim has very little difficulty
drawing images in accurate perspective that the old masters could only do with
sophisticated technical aids. What most people, including skilled artists, would
find very difficult to do "by eye", Tim can do with little effort,
from memory, sometimes months later, and without any formal instruction or
training.

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Summary

At this time, Tim is clearly a talented savant, he may
even be prodigious. His special skills and abilities are highly
specialized, and are obviously conspicuous when viewed over against his over-all
handicap, he can draw in ways that most professional artists would find
impossible. Tim seems to fit with one view of savant syndrome as resulting from
a compensation for a sensory deficit, i.e. his deafness, and the possession of a
remarkable photographic memory. My wife has adopted the position that Tim’s
drawing ability would not have become so apparent if the communication barriers
had not been bridged. Tim has a need to be sure of, and trust, what is happening
around him. Without this need being met, Tim’s exceptional abilities would not
have had the chance to develop in the way that they have. Indeed, it is highly
unlikely that they would ever have been noticed at all.